Promoting reflection on bioethics and research ethics issues in Sub-Saharan Africa

Wednesday, October 31, 2007

Need a kid, kidney or a nosejob? Pack your bags for the global south

As I have mentioned before, global bioethics should be distinguished from the globalization of bioethics. The former is about whether there exists a common ethical framework, shared by humanity, within which bioethics questions can be discussed. That question is basically a variation on the old theme of universalism vs. relativism in ethics, and it is not likely to be resolved by, say, the next American Society for Bioethics and the Humanities meeting. The globalization of bioethics, on the other hand, not something to be sought after: it is a contemporary phenomenon, and we are stuck with it. The term refers to how the process of globalization raises bioethics issues, all over the place, where you perhaps might least expect them.

Some would argue there is no ethical problem here: you have clients with demands and you have agencies with supplies: why should it matter that the exchange involves international travel? But the relationship bears further scrutiny: the exchange is taking place across steep gradients of socio-economic and political inequality, and that has interesting ethical implications and side effects. Physical enhancement via high-tech surgery and the ability to have genetically related children despite natural impediments may become standard of care for the better-off in the developed world and the elites of 'less fortunate' countries, though the actual care may take place in some exotic destinations. The vast majority of people living in low-income countries are unlikely to have access to technologies that can liberate us from the vagaries of the natural lottery -- given their spotty access now to basic health care -- but they are still an important cogs in the globalization wheel. While much of the raw mineral resources of the global south have long been tapped (or expropriated), there are still vast human biological resources in low-income countries where the market is poorly regulated. Rent for a womb in Indore, India costs as little as R 200,000 ($5000), from which the surrogate mother gets $1200 (or $133 per month). Hiring a surgeon in Brazil to fix your breasts will set you back less, and the surgeon him- or herself may well enjoy the exchange, given that it brings more revenue than (say) operating on sick compatriots from the lower classes.

Michael Moore made Sicko. The world awaits a film director capable of faithfully conveying the human dimension of the globalization of bioethics.